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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c <br /> APPLICATION FOR LAND USE PERMITSqj <br /> a G� <br /> OWNER TELEPHONE✓/aD' SSoZ` S(�37 a <br /> l� �bn A+✓Ds�nJ <br /> MAILING ADDRESS .. <br /> 3z3o n9�i osNrSy✓� LT. U+2���,J 64y ti' 5-5'3c) / 0 <br /> PROPERTY AD RESS e <br /> �'!� Si4✓✓r� y9�E Sff�1163 77Zfk1Z !r/�5i-15 aus sYFs7 3 <br /> LEGAL DESCRIPTION y <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS <br /> TYPE OF PERMIT(S): 1,,� <br /> FILLING/GRADING yq CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ 1 <br /> STRUCTURE/ADDITION USE: zj iT <br /> A (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o_ ' <br /> BUILDING CONTRACTOR: /VOA)P__, ' <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n <br /> WILL BE RETURNED. K V <br /> h <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) — m <br /> 6 J <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tn+f d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ti <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, to w <br /> AND INDICATE NORTH (N). i <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK a <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N �, <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w C?• <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C? -� c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> C, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> W <br /> 09 O <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 3c Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !; C <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 6• <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> O a s ou,4-�wo( 6 BarSPJlBfzdn <br /> k �Yhe 8wrne-t�-Cou,�h� La+-,�tt,�af�/ <br /> l ' zAgjl, & , <br /> 7. H9 ow,' o,w <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge z m y <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information e g p <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Infornatlon I A <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all = N <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to .r. <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonable time for the purp se nspection. m c <br /> y <br /> OWNER'S SIGNATURE <br /> .f/ n - ( ate) zn <br /> ZONING ADMINISTRATOR tJ11/ I <br /> TOWNSHIP PERMITS MAY BE REQUIRED CN <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE trN o <br /> �'h 1 W-+kr fnd► I ed 'Clams <br />